By Lucinda Porter

There are many approaches to health. Some people are prevention oriented. They do what they can to optimize their circumstances. The image that comes to mind is that of a conscientious homeowner who annually checks the smoke detectors and never leaves empty gas cans on the premises.

Then there is the emergency approach to health. People who practice this tend to overlook prevention and wait until something drastic occurs. These people do not call the fire department unless the fire is out of control. Finally, there are those who ignore their health completely. The house is on fire but they still do not call for help.

Which approach do you practice? The ideal of course, is to practice prevention. Self-awareness can be the first step in the process of moving towards the prevention model.

The reality is that few of us do this consistently. Who has the time to do aerobic, resistance, and flexibility exercises? Add eating well, sleeping eight hours every night, flossing your teeth, meditating, having a social life, regular medical exams, and one has a formula for unmet expectations. Throw in some hepatitis C fatigue and brain fog and the recipe gets even murkier. So how is a person to take good care of him or herself?

First, prioritize. If you have chronic hepatitis C viral (HCV) infection, you smoke, and you drink alcohol, consider which factor is hurting you the most. In this example, quitting drinking would take precedence, followed by stopping smoking, followed by addressing the HCV. We know that alcohol use in the presence of HCV is a very serious matter.

We also know that many more people die each year from diseases related to smoking (more than 400,000) as compared to HCV related causes (10,000). I encounter many patients who smoke or drink and have HCV. They are very worried about their liver and overlook these other health risks. The house is on fire and they are worried about the smoke in the shed. The message here is this: attack your biggest risk factors first.

The second step is to make one change at a time. Trying to be perfect does not work. Modify one behavior at a time for at least one month or more. After you feel confident of your ability to maintain the new behavior, you can address a new arena. However, if you find that the first behavioral change is in jeopardy, back off the new one.

Third, take small steps. Some of these behaviors have been a part of our lives for many years.

Fourth, reward yourself for your attempts. If you are trying to lose weight and you stick to your food plan for a week, reward yourself. Link the reward to your behavior, not to the result. Even if you did not lose any weight, reward yourself for trying.

Fifth, turn relapses around as quickly as possible. Addiction experts note that the key to giving up an addiction is how quickly one recovers from a relapse, rather than how perfectly one kicks an addiction. The phrase "two steps forward, one step back" applies here.

Sixth, ask for help. There are many ways to make changes in our lives. Sometimes it is just a matter of finding the right one at the right time. Support groups and the Internet can be useful resources.

Finally, above all be kind to yourself. Never condemn your efforts. Chastisement only makes us feel bad about ourselves. In order to feel better, people pick up old habits, which create a vicious cycle. The easiest way to break the cycle is to forgive yourself.

_{Lucinda K. Porter, RN is a research nurse and patient educator at
Stanford in the area of hepatology. She co-facilitates a support group and
is active in many aspects of hepatitis C education. In addition to being HCV+,
she has a life which include her husband and teenaged daughter.

Copyright Lucinda K. Porter 1999}